U.S. Hospital Industry Restructuring and the Hospital Safety Net

Abstract

The U.S. hospital industry was reshaped during the 1990s, with many hospitals becoming members of health systems and networks. Our research examines whether safety net hospitals (SNHs) were generally included or excluded from these arrangements, and the factors associated with their involvement. Our analysis draws on the earlier work of Alexander and Morrisey (1988), and not only studies factors affecting SNH participation in multihospital arrangements but also updates their earlier study. We constructed measures for hospital market conditions, management, and mission, and examined network and system affiliation patterns between 1994 and 1998. Our findings suggest that larger and more technically advanced hospitals joined systems in the 1990s, which contrasts with 1980s findings that smaller, financially weak institutions joined systems. Further, SNH participation in networks and systems was more common when hospitals faced less market pressure and where only a limited number of unaffiliated hospitals remained. If networks and systems are key parties in negotiating with private payers, SNHs may be going it alone in these negotiations in highly competitive markets.

The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services

“…Researchers have used various methods to identify SNHs, with some focusing exclusively on public hospitals (Marquis, Rogowski, and Escarce ), others on public hospitals and academic medical centers (Baxter and Mechanic ; Fishman and Bentley ), and still others using hospital data on uncompensated or Medicaid care to assess hospital safety net involvement (Cunningham and Tu ; Zuckerman et al. ; Bazzoli, Manheim, and Waters ; Bazzoli et al. ).…”

“…Although this may happen at the margins (e.g., hospitals near the SNH threshold), Bazzoli et al. (), Bazzoli, Manheim, and Waters () found that about three‐quarters of SNHs identified using a similar approach were identified as SNHs 3 years later.…”

Hospital Staffing Decisions: Does Financial Performance Matter?

“…This is consistent with Bamezai et al (1999), who found that HMO penetration reduced hospital cost growth by the greatest amount in the most competitive hospital markets. Finally, since county economic and demographic factors may affect demand for a hospital's services, county per capita income, the percentage of population aged 65 or older, and total beds per 1,000 population are included in the model Sari 2002;Bazzoli, Manheim, and Waters 2003).…”

Changes in the Health Care Safety Net 1992–2003: Disparities in Access for Uninsured Persons in Florida

“…Various methods include focusing exclusively on public hospitals (9), using public hospitals and academic medical centers (26, 27), or using hospital data on uncompensated or Medicaid care to assess hospital safety net involvement (13, 28, 29, 30). Gaskin et al (31) and Hadley and Cunningham (12) blended these various approaches, using public hospitals and a select group of non-profit SNHs with disproportionate provision of care to Medicaid patients to identify SNHs.…”